Background & Aims

Chronic shoulder pain often leads to avoidance behavior, contributing to long-term disability (MARTINEZ-CALDERON et al., 2018; BARTLETT; FARNSWORTH, 2021). However, there is not a specific score indicating high avoidance behavior in individuals with shoulder pain. Thus, this study aimed to identify an optimal cutoff score on the Avoidance Daily Activities Photo Scale (ADAP Shoulder Scale) for high avoidance behavior in chronic shoulder pain.

Methods

This study recruited 102 individuals with chronic shoulder pain from physiotherapy. Individuals were assessed for avoidance behavior by the ADAP Shoulder Scale (ANSANELLO et al., 2022, 2023). The shoulder pain and disability were assessed using the Shoulder Pain and Disability Index (SPADI) and kinesiophobia using the Tampa Scale of Kinesiophobia (TSK-17). Spearman’s correlation was conducted prior to the Receiver Operating Characteristic (ROC) curve analyses to identify the association of avoidance behavior with shoulder disability (SPADI) and fear of movement (TSK). The optimal cutoff value for high avoidance behavior on the ADAP Shoulder Scale was obtained by the ROC curve analyses, which distinguished individuals with lower (score below the 50th percentile) and higher (score above the 50th percentile) disability or fear of movement. The area under the ROC curve (AUC) analyzed the accuracy of the optimal cutoff value of avoidance behavior.

Results

The ADAP Shoulder Scale total score showed a moderate correlation with the TSK-17 (r = 0.61) and a high correlation with the SPADI scale (r = 0.77). The distribution of the disability and fear of movement scores in percentiles resulted in the 50th percentile of 60.50 points for the SPADI and 43.00 points for the TSK-17. The accuracy of the ADAP Shoulder Scale was higher in distinguishing individuals with greater disability (AUC 0.89; 95% CI 0.82 to 0.96) than in fear of movement (AUC 0.77; 95%CI 0.68 to 0.87). The optimal cutoff value of 55.0 points on the ADAP Shoulder Scale (sensitivity = 0.82, specificity =0.84) identified the individual with the greatest disability and can be considered as a score indicative of high avoidance behavior.

Conclusions

The study showed that a high avoidance behavior is expected for individuals with chronic shoulder pain with a score equal to or greater than 55.0 points on the ADAP Shoulder Scale.

References

ANSANELLO, W.; DOS REIS, F. J. J.; TOZZO, M. C.; ZATITI, S. C. A. et al. Development of the Avoidance Daily Activities Photo Scale for Patients With Shoulder Pain. Phys Ther, v. 102, n. 2, p. pzab268. 2022.

ANSANELLO, W.; DOS REIS, F. J. J.; TOZZO, M. C.; ZATITI, S. C. A. et al. Reliability and validity of the Avoidance of Daily Activities Photo Scale for patients with shoulder pain (ADAP Shoulder Scale). Physical Therapy, p. pzad101, 2023.

BARTLETT, O.; FARNSWORTH, J. L. the influence of kinesiophobia on perceived disability in patients with an upper-extremity injury: a critically appraised topic. J Sport Rehabil, 30, n. 5, p. 818-823, 2021

MARTINEZ-CALDERON, J.; STRUYF, F.; MEEUS, M.; LUQUE-SUAREZ, A. The association between pain beliefs and pain intensity and/or disability in people with shoulder pain: A systematic review. Musculoskelet Sci Pract, v. 37, p. 29-57, 2018.

Presenting Author

Jacqueline Martins Priuli

Poster Authors

Jaqueline Martins Priuli

M.Sc

University of São Paulo, Ribeirão Preto, São Paulo/Brazil

Lead Author

E-mail

Marcela Camargo Tozzo

Universidade de São Paulo

Lead Author

E-mail

Mirella Cuaglio Sampaio

Universidade de São Paulo

Lead Author

E-mail

Rafael Alaiti

Universidade de São Paulo

Lead Author

E-mail

Walter Ansanello

Universidade de São Paulo

Lead Author

E-mail

Anamaria Siriani de Oliveira

Universidade de São Paulo

Lead Author

E-mail

Topics

  • Assessment and Diagnosis